History of Management of Infratentorial Ependymomas in Children

Understanding of Disease

• Surgery best treatment: Before the era of MRI, an infratentorial ependymoma was considered a tumor for which total resection was impossible. Brain MRI and modern microsurgical techniques have made radical resection feasible with fewer complications and better survival rates. Because of the strong correlation between extent of resection and survival, aggressive surgical resection is the most important treatment modality for pediatric infratentorial ependymomas.

Technological Development

• Surgical microscope: With popularization of microsurgical techniques and advances in imaging, especially MRI, radical resection of posterior fossa infratentorial ependymomas became more feasible.

Surgical Technique

• Surgical guidance: Microscopic surgery with detailed preoperative and intraoperative brain imaging, electrophysiological monitoring, and neuronavigation have improved the surgical outcomes.